Breast cancer action plan for Kentucky.

In 1998, Governor Paul E. Patton established the Kentucky Breast Cancer Task Force (KBCTF) to assess and make recommendations on the availability, accessibility, utilization, quality, and outcomes of breast cancer services across the spectrum of disease. Over a two-year period, the KBCTF reviewed the state of breast cancer control in Kentucky and made recommendations for reducing breast cancer morbidity and mortality. To achieve the provision of optimal breast cancer care, the KBCTF recommended universal adoption of professionally accepted guidelines for breast cancer treatment, pain management, and distress management. To better coordinate public education on breast cancer, the KBCTF recommended the development of a standardized packet of public education materials for dissemination through regional networks of "cancer control partners." KBCTF members also requested the Kentucky Cancer Program to investigate the feasibility of establishing a centralized mammography registry to gather more complete data on screening mammography programs.

The effectiveness of a tobacco prevention program with adolescents living in a tobacco-producing region.

OBJECTIVES: This study investigated the efficacy of a social-influences tobacco prevention program conducted with adolescents living in a high tobacco production area. METHODS: Students in 10 experimental schools completed the tobacco prevention program and a booster intervention. Control students received health education as usual. RESULTS: After 2 years of treatment, smoking rates in the treatment group (vs the control group) were lower for 30-day, 7-day, and 24-hour smoking. The intervention had more of an impact on those who were involved in raising tobacco than it did on those not involved in raising tobacco. CONCLUSIONS: Although modest, effects were achieved with minimal intervention time in a high-risk group, indicating that social-influences prevention programs may be effective in such groups.

What providers should know about community cancer control.

PURPOSE: The authors describe a framework for developing an effective, community-focused cancer control program. OVERVIEW: Progress in the application of cancer control interventions has proven to be quite variable across different populations and communities. The Kentucky Cancer Program, developed under joint sponsorship of cancer centers at two state universities, has been using a model that appears to provide a high degree of sensitivity to community-specific problems and solutions. The Kentucky four-step model includes 1) using data from a population-based cancer registry and other sources to identify problems; 2) ensuring community involvement with providers in selecting the target population and developing the intervention strategy; 3) implementing the intervention plan; and 4) using cancer registry and other data to evaluate the impact of this intervention. CLINICAL IMPLICATIONS: This framework may be useful to providers as they try to balance the goals of their clinical practice and the goals of community cancer control. Developing an effective, community-focused cancer control program requires that providers gain a solid knowledge about their community. The depth and richness of that knowledge base is enhanced by the active participation of community members as they collaborate with the providers on planning and implementing cancer control activities.

Relationship of personal tobacco-raising, parental smoking, and other factors to tobacco use among adolescents living in a tobacco-producing region.

This study examined factors related to tobacco use among youth from tobacco-raising (TRH) and nonraising households (NRH). The subjects were 3,851 seventh-grade students from 19 middle schools located in a tobacco-raising region. Valid self-reports of tobacco use were encouraged by the use of a test for carbon monoxide in expired air. Cigarette use was higher when (a) at least one parent smoked, and/or (b) the student personally raised tobacco. A boy who personally raised tobacco and had at least one parent who smoked was 10.2 times more likely to have smoked in the last 7 days than a boy from a nonraising household in which neither parent smoked. For girls, the odds ratio was 5.6:1. Tobacco use among students in this high-risk group was higher than rates reported in national or regional studies. Other results were: (1) use began very early--16% of the students had tried cigarettes and 13% of the boys had tried smokeless tobacco (SLT) in Grade 3 or earlier; and (2) users reported more lenient rules at home regarding tobacco use than did nonusers. Years from now, these high-risk students are likely to be major contributors to increased morbidity and mortality due to tobacco use. Implications for tobacco prevention in tobacco-raising areas are discussed.

Use of snuff, chewing tobacco, and cigarettes among adolescents in a tobacco-producing area.

This study describes the prevalence and patterns of smokeless tobacco and cigarette use among adolescents with a specific focus on those living in a high tobacco production area. The subjects were 582 male and 485 female students in grades 7 through 12, with 54% living in a rural (nonmetro) area and the remainder living in an urban (metro) area. Self-reports of tobacco usage were validated using biochemical tests. High smokeless tobacco usage rates were found among nonmetro males--90% had tried one or more smokeless tobacco products and 33% had used at least one of the products in the last 6 days. Students' tobacco usage increased dramatically as the degree of personal involvement in raising tobacco increased. Of senior high boys who had household involvement in tobacco, 100% had tried snuff and 42% had used it in the last 6 days; 80% had tried cigarettes and 53% had used them in the last 6 days. Some other results were: (1) use of snuff was more popular than chewing tobacco, (2) the average grade for initiation to tobacco was the fourth grade for nonmetro students and the fifth grade for metro students, and (3) a large number of male smokeless users also reported cigarette use. Students from tobacco-raising households are at high risk for tobacco use. Future research should focus on effective prevention methods for high-risk students.

Saliva cotinine and thiocyanate: chemical indicators of smokeless tobacco and cigarette use in adolescents.

Recent attempts to measure smoking behavior using chemical tests may have been confounded by the use of smokeless tobacco. An objective measure of smokeless tobacco use is needed, particularly among adolescents who may not provide accurate self-reports of tobacco usage. Saliva cotinine was used to distinguish self-reported tobacco users from nonusers and a combination of saliva cotinine and thiocyanate (SCN) tests was used to distinguish smokers from smokeless tobacco users. The subjects were 471 students in grades 7 through 11 who lived in a high-tobacco production area. Approximately 89% of reported nonusers had no detectable cotinine and 99% of nonusers had levels less than 25 ng/ml. Of those who had used tobacco within the last 12 hr, 95% had detectable levels of cotinine. Samples that tested positive for cotinine were also tested for SCN. Eighty-six percent of smokers and 74% of mixed users had SCN values of greater than 1000 mumol/liter, while only 14% of smokeless users had SCN values at that level. The combination of cotinine and SCN was effective in distinguishing smokers from smokeless users but was not effective in distinguishing mixed use from the other two types of use.